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Zhu Danxi stated: The *Classic of Internal Medicine* (*Huangdi Neijing*) records that "aversion to cold and shivering all belong to heat," and further states that "trembling as if losing one's spiritual hold all belong to fire." By "aversion to cold," even in the hottest months, upon encountering wind and frost while wearing heavy cotton clothing, one feels intensely cold and shivers. "Trembling" refers to a state of instability and shaking; "as if losing one's spiritual hold" describes an extreme severity of aversion to cold. Li Dongyuan, in his *Yuan Bing Shi* (Treatise on the Origin of Diseases), stated: When a disease is extremely hot but the patient feels cold, this is caused by pathological heat, not true cold.

Someone asked: It is often seen that patients feel slightly better after taking warm-natured medicines. Why is this? I replied: In patients with heat diseases, their qi flares upward and stagnates into phlegm-fluids, obstructing the clear pathways. This prevents yin qi from ascending, exacerbating the heat condition. When accumulated phlegm encounters warm medicine, it may temporarily recede, but the heat energy aids the pathogenic factor, causing the disease to deepen further.

Another asked: Given such apparent cold signs, who would dare to use cold-natured medicines? Would that not be tantamount to killing them? I replied: In ancient times, for cases presenting with shivering, there are records of cure using Da Cheng Qi Tang (Major Order the Qi Decoction) to purge dry feces. There are also cases of aversion to cold and shivering that are clearly heat syndromes, requiring differentiation between deficiency and excess. The *Classic* states: "Yin deficiency leads to fever." Yang resides outside as the guard of Yin, and Yin resides inside as the keeper of Yang. If spirit wanders outward and desires are unregulated, Yin qi dissipates, leaving Yang without attachment. Consequently, Yang floats and scatters at the muscle-surface level, resulting in aversion to heat. This is essentially not excess heat; it should be treated as Yin deficiency using nourishing methods.

Someone asked: Aversion to cold is not true cold, so cold medicines are appropriate; aversion to heat is not true heat, so tonifying medicines are appropriate. This is startling to the ears and eyes. Please explicitly instruct me on the treatment method. I replied: Zhou Bendao, a Jinshi scholar over thirty years old, suffered from aversion to cold. After taking hundreds of Fuzi (Prepared Aconite Root), his condition worsened, so he sought my treatment. His pulse was wiry yet seemed slow. I administered Jiangcha (River Tea) mixed with Jiangzhi (Ginger Juice) and a little Xiangyou (Sesame Oil) to induce vomiting, expelling about one liter of phlegm. His condition improved by more than half. Subsequently, I prescribed Fangfeng Tongsheng San (Wind-Barrier Universal Rescue Powder), removing Mangxiao (Mirabilite) and Dahuang (Rhubarb Root and Rhizome), and adding Dihuang (Rehmannia Root) and Danggui (Angelica Sinensis Root). He took over a hundred doses before stabilizing. Mr. Zhou was very pleased, but I said, "It is not finished. Dryness-heat is abundant, and blood injury is deep. He must eat bland food to nourish the Stomach and practice inner contemplation to nourish the Spirit, so that Kidney Water can generate and Heart Fire can descend." He did not follow my advice, prioritizing official advancement and ignoring all dietary and lifestyle restrictions. I warned, "If given more blood-tonifying and cooling medicines, he might stabilize slightly, but internal and external imbalance will persist, Kidney Water will not generate, and the toxicity of Fuzi will inevitably erupt." After recovery, he served as an official in Wucheng. During night patrols, he caught cold, which could only be treated with Fuzi. However, he feared Shengjiang (Fresh Ginger), so he boiled Fuzi with sliced pig kidneys and took three doses to stabilize. I advised, "You should return immediately, knowing that your Fuzi toxicity is prone to eruption." He considered me pedantic. Half a year later, he died from a carbuncle on his back.

Another case is Si Chengshu, whose feet below the ankles always felt hot throughout his life; he could not wear wool socks even in winter. He often claimed, "My constitution is strong; I am not afraid of cold." I said, "This is deficiency of the Three Yin meridities of the foot. You should abstain from sexual activity early on to tonify and nourish Yin-blood, perhaps avoiding disaster." He smiled and did not answer. At only fifty years old, he developed Wei Syndrome (Flaccidity Syndrome) and died six months later. Observing these two cases, the treatment principles may be understood.

Someone asked: Do aversion to cold and aversion to heat in Shanghan (Cold Damage) diseases present similarly? I replied: For Shanghan diseases, where pathogens enter from the exterior to the interior, the sages have discussed this in detail. What need is there for me to add赘言 (superfluous words)?

Respectfully noted: Li Dongyuan stated: Fever, aversion to heat, incessant great thirst, irritability, muscle heat, and reluctance to be near clothes, accompanied by a洪大 (Surging-Large) pulse that is empty upon deep pressure, or without symptoms like eye pain or nasal dryness, do not constitute Baihu Tang (White Tiger Decoction) syndrome. This is irritability due to Blood deficiency, which should be primarily treated with Danggui Buxue Tang (Angelica Tonify the Blood Decoction). Furthermore, there are cases of heat due to Fire stagnation, such as inability to eat, spontaneous sweating, and shortness of breath, which indicate deficiency. These require sweet-cold herbs to drain heat and tonify Qi. This differs from cases where the patient can eat, has dry mouth and tongue, and difficult defecation, which require bitter-acrid and major-cold herbs to purge and drain heat while replenishing fluids. These must be carefully distinguished and cannot be generalized. The above points should be referenced. Regarding irritability versus false irritability, they differ from true irritability. Irritability in Shanghan is a syndrome of True Yang trapped internally and hidden Yang within Yin, which is fundamentally different from Yin-deficiency heat irritability.